Adrenal Fatigue is a term applied to a collection of nonspecific symptoms such as fatigue, anxiety, joint pain, insomnia, hypoglycemia, depression, nervousness, sleep disturbances and digestive problems presenting in an otherwise healthy person with normal laboratory test results. Over 50 percent of adults suffer from Adrenal Fatigue at one point or another in their adult life. Most recover without knowing they had Adrenal Fatigue Syndrome, but a minority fail to recover, and a smaller number continue to only get worse. In its worst form, a person can be bedridden and incapacitated. The term often shows up in popular health books and on alternative medicine websites. An Internet search of the words “Adrenal Fatigue” yield over 2.4 million results, with search threads ranging from the Mayo Clinic to the Hormone Foundation and alternative health forums. What is clear is that to the vast majority of conventional medicine physicians, other than the forward-thinking ones, this condition does not exist and is not real. Yet to the vast majority of sufferers, this condition is very real and indeed, can be quite debilitating.

How is it possible that such a widespread dysfunction that generates so much ongoing interest among the public be rebuked by many of the world’s most brilliant and well-trained physicians? How does one explain the cognitive dissonance among most conventional medicine physicians’ assessment that Adrenal Fatigue does not exist, while the real experience of many sufferers is that of incapacitation and the inability to hold down a job?

Clinical vs. Subclinical States of Illness

Eighty percent of the most common causes of death in age related illness results from cardiovascular disease, stroke, and cancer. These degenerative diseases gain a head start years before outward symptoms are detectable. For example, the average cancer takes over a decade to develop before a lump is felt or clinically detectable.

A lifetime of poor nutrition, stress, and environmental pollution erodes cellular protection, repair, and replacement—the very foundation of health. While outwardly one may appear normal and healthy by traditional standards, inward cellular damage and insult is taking place daily from pollution, stress, and the cellular oxidative process, coupled with endogenous and exogenous free radical attacks from a young age. By age 50, free radical attacks damage as much as 30 percent of our cellular protein. Fortunately, the body has endogenous self-repair mechanisms. However, this repair mechanism is not 100 percent efficient. Damage that escaped repair can lead to cellular mutation and ultimately organ dysfunction. Adrenal Fatigue may be the result of such continuous insult over time.

Modern laboratory and detection methods are far from perfect and lack the sensitivity to pick up signs early enough to warn us of impending danger. Modern medicine with its many tests are of tremendous value when symptoms turn catastrophic and gross system failure is obvious—when chest pain occurs, or brain function fails, or a lump appears. Until then, normal current testing results simply reinforce our denial that most adults who appear healthy have, in reality, already entered into a sub-clinical state of aging with multiple diseases well in place but undetectable by physical examination or laboratory tests. These progressive sub-clinical disease states include borderline hypertension, sub-optimal adrenal function and hormonal imbalance, reduced liver detoxification capacity, reduced gastric assimilation potential, metabolic imbalances, and sugar intolerance. They are mostly foreign to conventionally trained western physicians who are taught to think in terms of demonstrable pathology to define disease.

The Disease Continuum

It is not unusual to be seriously ill and symptom-free yet have normal laboratory values. Autopsy studies of those who died of sudden death from cardiac arrest have repeatedly shown a large proportion with clean coronary vessels and perfectly normal laboratory tests.

Health, in reality, comprises a full spectrum of wellness; a continuum that ranges from severe sickness at one end to optimum health at the other end. Each chronic disease exhibits a similar continuum. Conventional medicine tends to label a person as sick once they cross the threshold of normal laboratory reference based on data derived from general population statistics. Until one crosses the threshold, they are considered normal. This is an all-or-nothing approach. The body is not a light switch that flips from normal one day to become abnormal the next. Unfortunately, all that is in between is universally ignored. The advancement of preventive medicine as a medical specialty strives to arrest disease at its sub-clinical state and address these sub-clinical conditions well before they become serious.

Adrenal Insufficiency (Addison’s Disease)

Conventional medicine and its view of Adrenal Fatigue as largely a myth has foundational validity. From their perspective, there is only one disease state when it comes to adrenal weakness, and it is called adrenal insufficiency, or Addison’s disease.

Mild Adrenal Insufficiency — Is It Real?

Adrenal Fatigue is advanced by natural medicine professionals to denote a mild form of adrenal insufficiency where regular laboratory tests are normal but a person is symptomatic. It is also called by a variety of other names, including mild non-Addison’s adrenal insufficiency.

Modern medical practice relies heavily on laboratory tests and other diagnostic procedures in mechanized fashion to confirm the presence or absence of disease. Any other approach is considered unscientific. The importance of taking a detailed history and recognizing the uniqueness of each body as the key foundation of arriving at any diagnosis is quickly becoming a lost art, replaced by the over-reliance on laboratory tests. This works rather well for acute illness, because the clinical presentation is dramatic. For chronic conditions, this laboratory reliance model is less than ideal. Most, if not all, chronic conditions evolve through a sub-clinical state as mentioned above. In this state, symptoms are present but all relevant laboratory results are within normal limits.

At best, laboratory results serve to help physicians assess the clinical states. It was never designed to replace a detailed history and good clinical skills. Within the current medical framework of thinking, normal simply means the absence of detectable illness as evidenced by laboratory test results within a statistical range defined mathematically. The threshold of what is considered normal or abnormal is determined by man. It is therefore an imperfect science.

This approach to medicine is grossly incomplete in chronic conditions, to say the least. The problem is obvious. Sole reliance on laboratory testing as the definitive diagnostic tool is a flawed model. On one hand, many are not well but have normal test results. They are told nothing is wrong and sent home. On the other hand, by the time testing detects illness it may be too late. The result is the same: patients suffer unnecessarily.

The Adrenal Fatigue Debate

Let us examine the foundational premise advanced by naturally oriented physicians to support their thesis that Adrenal Fatigue is real.

The adrenal glands, like any other organ system, are subject to dysfunction due to intrinsic weakness or external insult anytime during our life. It secretes over fifty hormones and is largely responsible for helping the body deal with stress. Most of these hormones decrease after reaching a peak in our 20s. The gradual decline in hormonal health is first unnoticeable, especially in the adrenal glands. According to natural medicine physicians, fatigue is usually slight in the early stages of Adrenal Fatigue. A good night’s rest or a cup of coffee is usually all that is required to regain lost energy.

Because the adrenal glands constitute one of the main hormonal regulation centers of the body, it comes as no surprise that those with intrinsic adrenal weakness are most affected. Those who have severe childhood emotional trauma, excessive physical exertion, major surgery, and repeated pregnancies are particularly vulnerable.

Every chronic illness including hypertension, hypothyroidism, and diabetes progresses through a continuum from normal to severe in a graded state over time. Based on common sense alone, mild dysfunction of the adrenal glands is likely to exist regardless of the name it is given.

It is important to note, however, that while Adrenal Fatigue can explain may of the presenting symptoms, it often cannot fully explain ALL the symptoms presented by sufferers. There may be other conditions that clinically present itself with fatigue but the underlying root cause is NOT adrenal weakness.

Causes of Adrenal Fatigue from a Natural Medicine Perspective

According to natural medicine physicians, Adrenal Fatigue is largely caused by stress, either emotionally or physically.The theory is that your adrenal glands are unable to keep pace with the demands of perpetual fight-or-flight arousal and hormonal demands due to stressors. As a result, insufficient hormones are produced and fatigue is the result. Conventional medicine sees no scientific facts to support the theory that long-term mental, emotional, or physical stress drains the adrenal glands, leading to the common symptoms of fatigue and lethargy.

Conventional medicine acknowledges that symptoms of fatigue are real, but does not maintain that the adrenal system dysfunction plays a role as long as a test for Addison’s disease is negative. In other words, they believe the symptoms as reported by sufferers are accurate, but the cause lies outside the adrenal glands. Thus the diagnosis of Adrenal Fatigue is invalid and not real. Instead, they turn their attention to other syndromes that have similar clinical presentations, such as depression, chronic fatigue syndrome, and fibromyalgia. Adrenal Fatigue is rejected as a possibility. What is interesting is that these other diagnoses were themselves being considered invalid by conventional medicine.

Why Conventional Medicine Rejects Adrenal Fatigue

The basis of conventional medicine’s thesis that Adrenal Fatigue is not real revolves around two critical questions.

First, whether it can be proven that stress can lead to a physical imbalance of adrenal hormone output that can be quantified, and thus, considered as evidence. Second, whether this quantifiable imbalance is the root cause for symptoms of fatigue and lethargy.

Let us look more closely at each of these.

The advent of brain imaging and neuroscience research has proven without a doubt that a network of hormones connects the mind and body. Physical or emotional stress has been demonstrated and proven to be a strong trigger of quantifiable hormone release in the adrenal glands, including adrenaline and cortisol. Laboratory measurements of these hormones show varying results, depending on the state of the person and the stress level. Research has proven that in times of acute stress, our adrenaline (the hormone responsible for the fight-or-flight response) level rises quickly. At time of rest, it falls gradually. The degree of rise and fall, however, varies from one person to another. Some people under stress can release a large amount of adrenaline. In others, the rise is much more muted. When stress is chronic in nature, acute elevation does not occur. Often times, the change is hardly noticeable, perhaps because the body has other compensatory mechanisms in place. In other words, while we can say that there is a definite hormonal connection, the exact degree at this sub-clinical state has yet to be perfectly quantifiable with pinpoint accuracy. A general picture of hormonal imbalance can be seen.

To conventional medicine physicians, this does not meet the threshold of what they consider scientific evidence. To naturally oriented physicians, this is the best we can do given the current technology. We choose to accept it.

Next is the evaluation of sub-clinical hormone imbalance and the question as to whether or not this leads to clinical symptoms of fatigue and lethargy. The results are not perfectly clear. One can have high adrenaline levels and not feel fatigued, while others can be tired but have normal adrenaline blood levels. Again, presently there is no quantitative test of any kind that provides a direct and absolute correlation between the levels of any single adrenal hormonal to symptoms of fatigue with 100 percent accuracy.

Based on the above, we can surmise three possible deductions:

First, that the current laboratory test is incapable of measuring sub-clinical states. In other words, laboratory studies are not useful for this situation at all and therefore should be discarded.

Second, the current test is good, but the reference range lacks sensitivity to correlate to the sub-clinical state. What is needed is to redefine the reference ranges, or lower the threshold. This is not uncommon in the medical world.

Lastly, we can surmise that such sub-clinical states do not exist because current laboratory tests are accurate enough to cover the entire spectrum of adrenal health. There is no change necessary.

Unfortunately, the medical science relied on by conventional medicine has not yet advanced to a state where one can definitively argue for and defend any one of the above three scenarios to the complete exclusion of the others. Adrenal Fatigue is not the first condition to face this challenge. Many illnesses considered invalid in the past have subsequently become validated if one examines the history of medicine. In fact, this is the norm and not the exception. Most chronic diseases, if traced to their root history, experience resistance and rejection by the mainstream medical community of that era when first introduced. This is the norm. Their full acceptance into the medical community only comes decades later. Not many decades ago, depression, fibromyalgia, irritable bowel syndrome, and chronic fatigue were also considered invalid diagnoses by conventional medicine. Today, they are accepted illnesses.

Depression: Diagnosis Without Using Laboratory Tests

Let us take depression as an example. To qualify for a diagnosis of major depression, for example, one only has to, within a two-week period, have any five of the following symptoms that represent a change from previous function:

Depressed mood most of the day, by subjective account or observation

Insomnia nearly every day

Fatigue or loss of energy nearly every day

Feeling of worthlessness

Diminished ability to think or concentrate

Recurrent thoughts of death (not simply afraid of dying)

Significant weight loss or weight gain when not dieting

Psychomotor agitation as observed by others

Clearly none of the above nine criteria are laboratory driven or quantitative in nature. They are all subjective. Once a person has five of the symptoms, depression is diagnosed, and that becomes a medical fact. Your updated medical records will be with you for the rest of your life. Until they reach this diagnosis, a person is not considered depressed.

The obvious question then is what diagnosis is given to a person who has four out of the nine criteria? Is that person normal and thus unworthy of treatment? Borderline depression would be a logical diagnosis, but this does not exist. However, not all conditions face this problem. Borderline hypertension is a valid diagnosis, and so is borderline diabetes.

Dr. Lam’s Key Questions

What do you think of alternative treatments such as craniosacral therapy and EFT Tapping?

They are good treatments but make sure you consult your coach before starting.

Why do doctors want to use birth control to treat PCOS?

The use of birth control forces menstrual regularity and allows conventional doctors to regulate the flow and timing that is often disrupted by PCOS.

Why is it that glandular are not recommended, but the Doctors or the Naturopaths are always leading with them.

Most doctors are trained to improve symptoms the fastest way. They are not trained to build the body up from the foundation. Using glandular and adaptogen herbs, in my opinion, is not helping to improve the foundation of your body but patchwork. They do have their function at the proper time and place, but priority should always be to allow the body to self-heal first. Herbs and glandulars can help short term, but can potentially have long term issues.

What is the best way to go about speaking with your primary medical doctor and letting them know about AFS and that you do not want to take any hormones which are what they want to load the body with?

Thank you for enlightening traditional MDs like myself to understand something so common yet poorly understood in our conventional Medical practice. Once well, I hope to become your apprentice some day.

Dear Dr. Lam and associates,
My daughter has been suffering with IBS, extreme constipation, candida, and debilitating anxiety since she was born. She is now 28 years old and while we have come a long way determining her issues, we are at a loss at how to continue. The last medical doctor we went to finally discovered her cortisol levels were inconsistent and sometimes too low. We explained that we felt her fainting episodes were due to a drop in blood pressure and he agreed, putting her on Florinef. It worked to steady her blood pressure, but of course did not help her have a bowel movement or help her function under stress. After a year, she came off of that medicine and we found an adrenal fatigue supplement which works well to keep her from having dizzy spells. She has taken Prozac and Effexor to function. We are afraid to experiment with Tryptophan or 5HTP while she is on an SSRI without the supervision of a doctor who understands her condition. Every day for her is a struggle to get through, but through determination she lives a normal life, has a job and a husband. She is quite independent except when she goes into a major spiral of fear, but still, most days are a private Hell for her as she struggles with obsessive thoughts and fears about situations that most people would not even consider. She has every symptom that you or Trudy Scott have listed for deficiencies in serotonin, endorphins, vitamin D, catecholomines, and on and on. About five years ago, she got a stomach virus; when she got out of the bed three days later she looked like a skeleton. She has remained way too thin ever since then. She does not do well with dairy products and also avoids sugar as much as possible. She wants to come off of her SSRI drug and have a baby. How does she proceed? Please help us; we need a miracle.

Continue to seek professional care with doctors you feel comforatble with. Her situation is complex and well beyond what a public forum like this can help. Call my office if you need further help as we have a telephone coaching program that may be helpful to you if you qualfiy.

It amazes me how much conventional medicine basically laughs at adrenal fatigue. When you break it down, Dr. Lam, it seems so simple to start connecting all the dots! Mainstream medicine is one of the biggest $$$ for profit scams, why do they mess with people’s health?? Thank you so much for all you do.

I have just been through the process with conventional medicine and they cannot diagnose/help me. I have clear physical symptoms and biomarkers which are easily reproducible yet I’m told there is nothing they can do for me yet reject adrenal fatigue/exhaustion. It’s good to see greater acknowledgement of this – through various websites on the subject I have found ways to deal with it and become human again, something again I can prove with physical symptoms and other biomarkers. It would be interesting to speak to people doing real research into this.

it amazes me that regular MDs are basically laughing people like us off thinking its “all in our head”. What will it take for these guys to realize this is a real thing?? thank you for all your articles, you should have your own show so you could enighten these other folks!

Start with getting more educated and avoid the 7 most common mistakes. Click 7 Adrenal Fatigue Recovery Mistakes for more information. We have a telephone coaching service if you would like further assistance.

As much as not having AFS recognized, in some ways isn’t it better to leave it as a syndrome?

It seems like to me this allows for more natural treatment options, without medicines being added to the market that confuse people suffering. Would AFS sufferers really benefit from a medical diagnosis?

Where do I begin? Back in 1993 I was diagnosed with fibromyalgia. So for me, being “fatigued” was normal. Then in 2009 the fatigue became so pronounced I couldn’t get out of bed. It took every ounce of energy just to get up and walk 20 feet to the bathroom. The doctor took multiple blood tests but everything was supposedly normal. Then the pain set in. I continually doubled over in severe abdominal pain, was rushed to the ER 35 times in one year. I had so many CTs I am surprised I don’t glow in the dark yet. I always felt feverish, but since my body temperature normally runs around 96, doctors never picked up a fever according to the thermometer. It honestly felt as if my brain were floating in water. Then finally I got so sick I could barely walk. Somehow I made it to the doctor’s office; this time it registered 103. She took more blood, this time thinking it was my appendix and sent me for a CT at the out patient center at the hosptial. When I got there, I got out of my car and collapsed on the ground. Security immediately wheeled me to the ER, where I was admitted. I had inflammation of the liver and bile ducts, and a ruptured ovarian cyst.

Still though, I continued to have stomach pain and debilitating fatigue. Twice I was rushed to the hosptial because I felt as if I were having a heart attack.

Finally, a friend of mine talked me into seeing her chiropractor/holistic doctor. He took one look at my “normal” blood tests and suspected I had hypoglycemia, sent me for additional tests, where that was confirmed. He also tested my adrenals and tested me for food allergies. Both came back positive. I do not remember the exact numbers from back then, but I can tell you that they were really messed up. Where they should be high, mine were low. Where they should be low, mine were high. Where they should be leveling off, mine dropped to practically nothing.

Fast forward to 2014. I lost my job and my home. I had to move to West Virginia and live with my step father because I couldn’t find a job anywhere in Florida. While working freelance, I developed tendonitis/carpal tunnel symptoms in my wrist and thumb. It did not respond to rest, braces, ice, heat, physical therapy, NSAIDS, cordizone shots (this made me ten times worse), boswellia, serrapeptase, bromlean, or anything else. Now I feel as if my homones are out of control. I feel tired all the time, I awake five or six times during the night to urinate. I have not had my period in three months. I have gained 30 pounds. I always crave salt/sugar. I can’t get through the day without a nap. The slightest things will exhaust me, cause my muscles/tendons to tighten up. My wrists and forearms feel sort of like an electric toothache. It is a deep pain like a toothache, but it cannot be alleviated even with narcotic pain meds. Simultaneously, if feels as if there is electricity running through my forearms/wrists/fingers. TSH blood test came back normal. I wonder if this is adrenals, thyroid, perimenapause or a combination (I am 46). I have been unable to hold down a job because the pain is so bad. How do you work with no hands?

I am on medicaid/foodstamps, so unfortunately, I can only see a conventional doctor. Medicaid doesn’t cover holistic/naturopathic medicine. What can i do? I am desparate, and I can’t get my doctor to run any tests at all. He just tells me to see an orthopedic and get surgery.

I understand your plight and can feel your pain. There are some conventional doctors who are forward looking. You can help educated them with my articles on line. The more they are educated, the easier it is for them to help you.

This is less, but let me warn you that a little information can be bad as it does not paint the whole picture, and that is why the book is 500 pages long. it is that long for a reason. Click Adrenal Exhaustion for more information on a more condensed article.

I disagree that the medical community hasn’t recognized it. They call it “postural orthostatic tachycardia syndrome” which isn’t to say that tachycardia CAUSES the symptoms, but is the diagnostic criteria for the syndrome. They believe it is caused by low blood volume (fluid depletion) and/or a dysfunction in the body’s ability to constrict blood vessels appropriately to maintain adequate blood supply. Both of these conditions leads to an increase in heart rate and the result? Crushing fatigue to begin with and a host of things that can’t yet explain but are common to those suffering from it. I had heart valve replacement 19 months ago due to a congenitial defect and when my own symptoms of POTS began I thought something was wrong with my heart again. It is thought that the stress of surgery may have caused mine. People have also been diagnosed with it after a viral illness. I think this is the same thing people are experiencing.

I always thought stress was a major part of why i wasn’t feeling well, this is a great article as it explains that more thoroughly. I do understand why adrenal fatigue is not recognized, but i am able to see that it is a real issue and i am ready to get better.

hello Dr. ; tnx fer ur understanding of adrenal problems…i have had long term adrenal related exhaustion symptoms and a accupunctuer test to confirm the problem…currently on hydrocortizone and armour thyroid…was delighted to find ur site…will call ur office monday june 13,…am running out of ways to cope after many years of trouble…blase j furfaro

Our telephone nutritional coaching program is nutritional based and for the vast majority of the situation,that is all you need. To be safe, you need to have a primarily doc available in case there are medical issues beyond what nutrition can support when needed. Any primary care doctor that you feel comfortable with will do. We do realize that they do not understand AFS. That is ok.

Can you backup these statements? I don’t see any references here and this figure “Over 50 percent of adults suffer from Adrenal Fatigue at one point or another in their adult life” where is it coming from? Your site would be a lot more credible less quackery if you provided sources.

That this disorder comes from adrenal “fatigue” is an opinion not shared by the majority of the medical community, but there is something called “postural orthostatic tachycardia syndrome” which I believe is the same thing. The title refers to the diagnostic criteria (as determined by a tilt table test) and the symptoms are nearly identical to those of what others call “adrenal fatigue”. Has only been recognized for about 20 years and they still don’t know a lot about it, but the stress of major surgery or an illness has been blamed in many cases. The underlying cause is thought to be low blood volume and/or dysregulation of blood vessel dilation. http://patient.info/health/postural-tachycardia-syndrome-pots-leaflet